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Evaluation of hospitalizations in a 70+ population showed that hip fractures (HF) were associated with a significant increase in the utilization of inpatient care for a lengthy period. Hospital days attributable to several diagnostic classes still exceeded both prefracture and population levels in the second year after HF. The goal was to assess effects of HF on the inpatient care utilization. The study covered HF patients and the 70+general population (26,000) living in Central Finland. Hospitalization data categorized by the ICD-10 main classes were obtained from the nationwide discharge register. In 2002–2003, 498 residents (mean age 82 SD 7, 74.9% women) of the study area sustained HF. Among them, the number of hospital days was 23, 107, and 52 per person-year in the prefracture, first and second postfracture year, respectively. In the 70+ general population, the number was constantly 11 per year. The age- and gender-adjusted rate ratio of hospital days between the two groups was 1.30 (95% CI 1.27 to 1.32), 6.91 (95% CI 6.85 to 7.00), and 3.61 (95% CI 3.55 to 3.67) for the prefracture, first and second postfracture year, respectively. Hospital days due to injuries were more prevalent in the HF group throughout the period. Moreover, excess of days was seen in six other diagnostic classes in the first and in four classes in the second postfracture year. Hospital days in HF patients still exceeded both the prefracture and population levels in the second year after HF. Days attributable to several other causes than HF itself became also more prevalent indicating that HF can steeply decrease patients’ coping capacity and launch a cascade of impairments in the function of different organ systems. [ABSTRACT FROM AUTHOR]

Background: Falls in older people are associated with poor prognosis. Medication use is a potential cause of falls. Our aim was to systemically review all original articles examining medication use as a risk factor for falls or fall-related fractures in people aged >/=60 years.Methods: We searched English articles in Medline (1996-2004) indexed under "falls" or "accidental falls" and "pharmaceutical preparations" or specific groups of drugs. We excluded studies not meeting the age criterion, not controlled with nonusers of target medicines or nonfallers, or with no clear definition of target medication.Results: Twenty-eight observational studies and one randomized controlled trial met the inclusion criteria. The number of participants ranged from 70 to 132,873. The outcome measure was a fall in 22 studies and a fracture in 7 studies. The main group of drugs associated with an increased risk of falling was psychotropics: benzodiazepines, antidepressants, and antipsychotics. Antiepileptics and drugs that lower blood pressure were weakly associated with falls.Conclusions: Central nervous system drugs, especially psychotropics, seem to be associated with an increased risk of falls. The quality of observational studies needs to be improved, for many appear to lack even a clear definition of a fall, target medicines, or prospective follow-up. Many drugs commonly used by older persons are not systematically studied as risk factors for falls. [ABSTRACT FROM AUTHOR]

We studied the incidence of second hip fractures and medication use among the patients with sequential hip fractures. This study shows that the incidence rate of second hip fractures is higher than that of the first hip fractures. Improvement in osteoporosis care and a more critical policy for prescription of psychotropic drugs are needed. This study had two goals: (1) to determine incidence of second hip fractures; (2) to describe changes in pharmacotherapy between first and second hip fractures, especially the use of those psychotropics which increase the risk of falling and also pharmacotherapy for osteoporosis. The residents of Central Finland Health Care District who had sustained a hip fracture in 2002–2003 were followed up for subsequent hip fractures until 2006. Hip fracture patients were identified and clinical data were obtained by using hospital registers and medical records. Five hundred and one persons aged ≥ 60 years suffered their first hip fracture in 2002–2003. During the follow-up of 936 person-years, 34 second hip fractures occurred. The cumulative incidence of second hip fractures was 5.08% (95% CI: 3.30 to 7.78) at one year, and 8.11% (95% CI: 5.73 to 11.43) at two years after the first fracture. The second part of this study investigated 75 patients with two non-contemporaneous hip fractures. Between the first and second fractures, the number of psychotropic drug users rose from 27 (36%) to 44 (59%). At the time of second hip fracture, osteoporosis had been diagnosed in 17 (23%) patients only. Twelve (16%) patients used bisphosphonates or calcitonin, 15 (20%) used calcium and 9 (12%) vitamin D supplements. There is a high incidence of second hip fractures. Secondary prevention of hip fractures needs to be improved. In addition to adequate treatment for osteoporosis, more attention should be directed toward appropriate use of psychotropic drugs. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate antidepressant use in a nationwide cohort of persons with incident rheumatoid arthritis (RA) in 2000-2007 in Finland. Method: Register data from the Social Insurance Institution of Finland were used to evaluate antidepressant use in ≥ 50-year-old incident RA patients (n = 10 356) and the same-age general population. Results: Of the RA patients, 10.0% (n = 1034) had used antidepressants during the year preceding RA diagnosis. The cumulative incidence of antidepressant initiations after RA diagnosis was 11.4% [95% confidence interval (CI) 10.0-12.9] for men and 16.2% (95% CI 14.9-17.5) for women at the end of follow-up (mean 4.4 years). Female gender [age-adjusted hazard ratio (HR) 1.39, 95% CI 1.21-1.60] and increasing number of comorbidities (p for linearity < 0.001) predicted antidepressant initiations. In the last follow-up year, antidepressant use was at the same level among men with RA [prevalence rate ratio (PRR) 0.93, 95% CI 0.82-1.06] but lower among women (PRR 0.89, 95% CI 0.83-0.95) when compared to the general population. Conclusions: Antidepressant initiations in early RA were associated with female gender and comorbidity. Although depression is stated to be a sizeable problem in RA, the prevalence of antidepressant use did not exceed the population level. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the national pattern of strong opioid use among community-dwelling persons with and without Alzheimer's disease (AD) in Finland. All persons (n=28,093) with a diagnosis of AD in 2005 were identified by the Social Insurance Institution of Finland (SII). For each person with AD, the SII identified a comparison person individually matched in terms of age (±1year), sex, and region of residence. Records of all reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register. Conditional logistic regression was used to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for reimbursed opioid use. The age of the persons with and without AD ranged from 42 to 101 (mean 80.0) years, with men comprising 32.2% (n=9048) of persons. The annual prevalence of reimbursed opioid use was 3.0% (n=273) and 3.8% (n=727) among men and women with AD, respectively. The use of all reimbursed opioids was lower among persons with AD compared with those without AD (adjusted OR 0.77, 95% CI 0.71 to 0.84). The use of strong opioids (adjusted OR 1.26, 95% CI 1.05 to 1.51) and fentanyl (adjusted OR 1.44, 95% CI 1.13 to 1.83) was higher among persons with AD. Our study did not assess the stage or severity of AD, nor the opioid doses prescribed. However, the results highlight the challenges associated with diagnosing and treating pain in this population, and the importance of balancing the risk of adverse drug reactions against the ease of transdermal administration. Use of opioid analgesics was lower among 28,089 persons with Alzheimer's disease (AD) compared with individually matched comparison persons without AD. However, use of strong opioids and transdermal fentanyl was more prevalent among persons with AD. [ABSTRACT FROM AUTHOR]